The core surgery clerkship rotation, which occurs during year 3 of the undergraduate medicine program, includes four weeks of general surgery (or its related sub-disciplines) and two weeks of orthopedic surgery. Details regarding the rotation can be found in the Surgery Clerkship Manual. Additionally, students will have further exposure to another surgical discipline during their two week Surgery Selective. Surgical specialty options for selectives include: cardiac surgery, neurosurgery, otolaryngology/head and neck surgery, pediatric surgery, plastic surgery, thoracic surgery, urology and vascular surgery.
Core Surgery Clerkship Learning Objectives
By the end of the surgery rotation the clerk will:
1. Patient assessment and management
a. Perform an appropriate and focused history for patients with a core surgical presentation (see list 1) (Medical Expert, Communicator)
b. Perform an appropriate and focused physical examination for patients with a core surgical presentation (see list 1) (Medical Expert, Communicator)
c. Provide a diagnostic work-up for patients with a core surgical presentation (see list 1) (Medical Expert, Manager)
d. Interpret relevant diagnostic tests in the evaluation of patients with a core surgical presentation (see list 1) (Medical Expert)
e. Synthesize clinical and laboratory/diagnostic data to arrive at a differential diagnosis for all the core surgical presentation (see list 1) (Medical Expert)
f. Develop appropriate plans for the management of patients with the core surgical conditions (see list 2) (Medical Expert, Manager)
g. List the indications for referral for surgical conditions (see List 2) (Medical Expert)
h. Discuss the pathophysiology, epidemiology, natural history and prognosis of the core surgical conditions (see list 2) (Medical Expert)
i. Identify patients with life-threatening conditions (Medical Expert)
j. Manage the results of common pre-operative laboratory investigations prior to surgery (Medical Expert, Communicator)
k. Demonstrate knowledge of the significance and need for venous thromboembolism prophylaxis, antibiotic prophylaxis, fasting guidelines, and practically apply these during the rotation (Medical Expert)
l. Manage the fluid and electrolyte needs of surgical patients with the following conditions: dehydration, fluid overload, hyperkalemia, hypokalemia, hypercalcemia, hyperglycemia and hypoglycemia (Medical Expert, Communicator)
m. Perform the diagnostic work-up for common post-operative conditions/complications, including: fever, wound infections/problems, delirium, shortness of breath, chest pain and venothromboembolism (Medical Expert, Manager)
n. Perform the initial management for common post-operative conditions/complications, including fever, wound infections/problems, delirium, shortness of breath, chest pain and venothromboembolism (Medical Expert, Communicator)
2. Peri-procedural and procedural skills
a. Perform proper scrubbing, gowning and gloving (Medical Expert)
b. Perform aseptic technique and maintains sterility during the performance or assistance of surgical procedures (Medical Expert)
c. Demonstrate a basic facility in the use of common surgical instruments (forceps, scissors, scalpel, retractor, needle driver, electrocautery) (Medical Expert)
d. Administer appropriate local anaesthetic for procedures (when appropriate) (Medical Expert, Communicator)
e. List the contraindications and toxicities of local anaesthetics (Medical Expert)
f. Perform (under supervision) the following procedures: (Medical Expert, Communicator)
i. Foley catheter insertion (male and female)
ii. Nasogastric tube insertion
iii. Suture a simple wound
iv. Removal of sutures or staples in skin
v. Safe application and removal of a splint or cast
3. Communication skills and clinical documentation
a. Succinctly present a patient case to other members of the health care team (Medical Expert, Communicator, Collaborator)
b. Conduct an interactive oral presentation to a small group on a surgical-related topic (Medical Expert, Communicator, Scholar)
c. Build a therapeutic relationship with patients and their families by establishing rapport, communicating clearly, and providing explanations, education and recommendations when required (under supervision) (Medical Expert, Communicator, Professional)
d. Observe the elements of informed consent for surgical procedures (Medical Expert, Communicator, Professional)
e. Write/dictate clear, accurate, timely and concise records of clinical encounters and procedures (Medical Expert, Communicator, Manager, Professional)
4. Health advocacy
a. Appreciate the impact that socioeconomic factors have on the management of surgical patients (Medical Expert, Health Advocate)
b. Identify strategies for primary and secondary prevention of surgically-oriented problems (Medical Expert, Communicator, Health Advocate)
5. Clinical inquiry
-
- Apply the principles of evidence-based medicine and critical appraisal to seek answers to questions that arise during the care of surgical patients (Medical Expert, Scholar)
6. Professionalism
a. Exhibit professional behaviours, including honesty, integrity, commitment to responsibilities, compassion, respect, altruism and caring for patients and members of the health care team (Professional)
b. Protect patient confidentiality, privacy and autonomy (Health Advocate, Professional)
c. Recognize personal limitations and seek assistance when feeling overwhelmed (Manager, Professional)
d. Work effectively with other members of the health care team (intra and inter-professional) to assess, plan, provide and integrate care for the surgical patient (Communicator, Collaborator, Manager, Health Advocate, Professional)
e. Appreciate the roles and expertise that members of the multidisciplinary health care team provide to surgical patients (Professional)
f. Project a professional image in dress, manner, speech and interpersonal relationships that is consistent with the expectations for a physician by the public. (Professional)
g. Recognize and be sensitive to self-limitations and biases and ensure that these do not intrude on patient care. (Manager, Professional)
Core Surgical Presentations (LIST 1):
MASS: Neck/thyroid mass, breast lump (including nipple discharge), abdominal mass (intra-abdominal and abdominal wall, including groin), scrotal mass,
rectal/prostatic mass, lymphadenopathy
PAIN (acute and chronic): Abdominal pain and/or distension, scrotal pain, joint pain, upper and lower limb pain
BLOOD: Epistaxis, hemoptysis, upper and/or lower gastrointestinal bleed, hematuria
TRAUMA: Head, chest, abdominal, pelvic (including genitourinary), and limb injury, burns
OTHER: Dysphagia/odynophagia, jaundice, urinary obstruction, shock
Core Surgical Conditions (LIST 2):
ENT: Foreign body of nose or ear, tonsillitis, epistaxis, serous otitis, thyroid cancer/mass
BREAST: Benign masses (fibroadenoma, fibrocystic changes, abscess), malignant masses
RESPIRATORY: Solitary pulmonary nodule, pleural effusion (malignant and empyema), pneumothorax (spontaneous, traumatic, iatrogenic)
VASCULAR: Aortic dissection, aortic aneurysm, varicose veins, occlusive peripheral vascular disease
GASTROINTESTINAL: Acute abdomen (including appendicitis/diverticulitis/GI tract perforation), bowel obstruction, esophageal obstruction, GERD/gastritis/peptic ulcer disease, duodenal ulcer, mesenteric ischemia, biliary colic/cholelithiasis/cholecystitis/cholangitis, liver masses (benign vs. malignant), pancreatitis, colorectal carcinoma, colitis (including toxic megacolon), inflammatory bowel disease, anorectal diseases (anal fissure, anorectal abscess/fistula, hemorrhoids), pilonidal disease, hernias (inguinal, femoral, umbilical, incisional)
SKIN/SOFT TISSUE: necrotizing soft tissue infections, skin cancer, benign skin lesions (nevus, verrucae, epidermal inclusion cysts, lipoma)
GENITOURINARY: Hematuria (benign and malignant causes), BPH, renal colic, prostate cancer, UTI, scrotal masses (hydrocele, spermatocele, varicocele), scrotal pain (torsion, epididymitis/orchitis)
MUSCULOSKELETAL: Fractures (open and closed), dislocations, subluxations, compartment syndrome, septic joint, osteoarthritis, sport-related injuries
NEUROLOGICAL: Cerebral neoplasms, CNS infections (meningitis and abscess), primary impact injury (concussion to profound coma), epidural hematoma, subdural hematoma, subarachnoid hemorrhage, spinal cord injury, peripheral nerve injury/entrapment (carpal tunnel syndrome)
REQUIRED CLINICAL EXPERIENCES/SKILLS:
- Observe the process of informed consent of a patient in the inpatient/outpatient setting.
- Participate in the evaluation of patients with non-infectious postoperative complications in the inpatient/outpatient setting.
- Participate in the management of patients with infectious postoperative complications in the inpatient/outpatient setting.
- Participate in the management of postoperative fluid and electrolyte needs of a patient in the inpatient setting.
- Participate in the management of postoperative pain of a patient in the inpatient setting.
- Demonstrate acceptable scrub, gown and glove technique for operations.
- Write an appropriate operative report in the health record.
- Assess and manage a patient's postoperative wound in the inpatient/outpatient setting.
- Write appropriate postoperative orders in the health record.
- Be a surgical assistant (1st or 2nd assist) to operating surgeons.
- Write daily progress notes in the health record documenting an inpatient's hospital course.
- Demonstrate foley catheter insertion on an inpatient/outpatient.
- Demonstrate nasogastric tube insertion on an inpatient/outpatient.
- Demonstrate a simple wound closure in the inpatient/outpatient setting.
- Perform removal of skin sutures or staples in the inpatient/outpatient setting.
- Perform safe application and removal of a splint or cast in the inpatient/outpatient setting.
